On Institutional Mindfulness

Mindfulness is a particular way of paying attention to whatever our experience i

A short critical article on CBT and mindfulness proposing that we understand how the other side of responsibilisation is a kind of meditative detachment on the part of public institutions. This text is a brief look at what Institutional Mindfulness does.

Quote:
These specialists seek to persuade us that our troubles stem, not from the world in which we live, but from our lack of insight into ourselves and from our failure to take responsibility for what we think, feel, and do.

- Paul Moloney, The Therapy Industry (2013, p.1),

A few days ago in London's Kings Cross: the throng of commuters going home from high pressured and or precarious work,moving in swarms through the tightly regulated streets, exhausted bodies chaotically charging towards the station to be crammed onto trains that will carry them back to the satellite towns they can just afford to live in, having been pushed out or pulled towards this concrete hub in the global mega-city. The social nervous systems receives excitation from all around it: signs demand attention, while lights flash wildly, too many anonymous others barge past in their own directions, the iphone buzzes in the pocket, making its own small demand that you acknowledge some new update, some ephemeral message that is draped in the urgency of news, while the headphones worn to cleave a little distance from all this produces imperceptible micro-traumas, the cause of the tinnitus that keeps you awake at night (the meditation techniques helps a little).

The police are out in force, hi-vis and riot vans, because the football fans are out in force: a familiar ritual getting ready to play itself out in the late hours when the bars close and alcohol's pharmacodynamic disorientation produces bodies become a little too exuberant for the carefully regulated urban space. Fights will be fought and arrests will be made: the same predictable madness of those attempting to forget the crushing dimensions of their lives, a social prescription for the anxiety of late capitalism. As I walk through the city I grew up in and would abandon, out of a combination of unhappiness, panic, and the yearning for some other life, I am aware of the circuitry that cuts across and runs through all these bodies. The city is many things: infrastructure, organised space, economic nodal point, contested territory, the very terrain of class conflict. Tonight, the city strikes me as an infinitely excited collective nervous system, heavily augmented, extended beyond the skin's shallow surface, the slow violence of which plays out on each body. On Caledonian Road, people gathered to talk about the politics of mental health. The social nervous system is aware of its condition.

While I was waiting for the event to start I tried to pull together the loose outline of what I was going to say. Reading the Guardian online I came across an article: "Mental health is accepted in academia". I'd wanted to talk about the deterritorialisation of psychiatric power, the way in which deinstitutionalisation was not the closure of the hospital but its liberation from disciplinary enclosure. Instead of shutting down the hospital, deinstitutionalisation has opened it up, spreading it through society to infiltrate every area of our lives. Examples abound and are not limited to the relatively obvious sites such as outpatient clinics or the counselling departments of universities, the endless rows of self-help books, the lifestyle magazines that offer a double articulation of normative governance ("I'm ashamed of my body", shrieks one cover I read today). From the clinic to the clinicality of everydaylife we witness the transformation of sadness into depression, and the proliferation of calorie information appearing on all foods and drinks, intensifying the diagnositic idea of an eating disorder, generalising it, allowing it to flow out of the strictly clinical situation, a silent declaration that we are all disordered eaters now.

The Guardian article was written by an anonymous academic about the psychological fallout of postgraduate study in the academy. The author was uncertain about the relationship between academia and mental suffering. Eating disorders, sleep disturbances, social isolation, depression, self-harm, suicide: all consequences of the combination of the stress of postgraduate study and poor academic supervision. These students, partially included in the ranks of cognitive workers, those who produce value via the exploitation of their intellectual and creative capacities, are the new depressed worker.

Years of study, hugely exploitative work that rests on a fragile relation to capital (as highlighted by recent stories about adjunct professors), are among those exposed to a specific kind of "burn-out" coupled
to an increasingly insecure future. There is no guarantee of academic jobs after university. Yet I don't want to suggest that these cognitive workers are the hegemonic subjectivity of some putative cognitive capitalism. Capitalism deterritorialises all codes; there is no privileged capitalist formation.
Instead, I want to suggest that these worker-students, already indicative of the breakdown in the relation between work and non-work, knowledge and capital, values and value, exhibit many of the central symptoms of life under late capitalism. It isn't just that they exhibit the social and psychological wounds of capitalist subjugation- nobody escapes this fate, not even the capitalists themselves- but that they are also exposed to a practice that I would call Institutional Mindfulness (IM).

One of the techniques that has left the strictly clinical settings in order to infuse itself in all social formations (school, work, leisure, etc) is the cognitive-behavioural approach. I'm writing a history of how this diffusion occurred at the moment, so I won't focus on it here. Suffice to say that as psychiatry came to liberate itself from the aslyum its younger and ambitious siblings followed it.

Clinical psychology and counselling have long been rivals to orthodox psychiatry and psychoanalysis. Armed with an evidence-base rooted in experimental psychology methods, and able to point to the efficacy of certain behavioural therapies, these other psy-disciplines appeared as compacted and dense complexes of tradition and scientificity deployed in the name of committment to a pragmatics that was not wedded to arcane diagnositic nosological arguments. When CBT arrived on the scene the cheer went up: at last a scientific therapeutic approach with measurable outcomes! at last a technique that we can tweek and alter for every occasion! With the arrival of CBT came a relatively brief intervention that was also relatively cheap in terms of training and implementation, and that could be made to fit every form of psychological suffering. Today we have reached the point where it has become more-or-less accepted that CBT can be used with people diagnosed as schizophrenic, a position that was initially resisted (in part because of historical biases about the chronicity and irreversibility of psychosis that were unfounded). There is a lot to say about CBT in terms of its history, its temporality, its functional obsession with technique, its religiosity, its basic repackaging of the earlier orthodox psychoanalytic demand
that subjects be made to adapt to the world in which they found themselves. All this will be dealt with elsewhere. Here, I want to point to one of the unique features of CBT: its infinite plasticity.

When I was training as a psychiatric nurse, I undertook both a counselling course and a specific introductory course to CBT. On the first day of our CBT component, the lecturer strode confidently into the room, suit and tie, and, in a voice that was equal measure confidence and arrogance, declared
"there is no such thing as cognitive behavioural therapy". His meaning was simple: CBT is nothing more than a collection of techniques coupled to a rationalist pragmatics of adaptation. This is reflected in the fact that their is no CBT Bible. CBT's main theoretical contributors didn't concieve of their approaches as
CBT, with Albert Ellis producing Rational Emotive Behaviour Therapy and Aron Beck extolling the virtues of cognitive psychology. It is also reflected in the fact that the manuals that do exist are specified for each disorder they are deployed to deal with. If SSRIs are alleged to be specific for depressive disorders,
then CBT-for-depression is specific for depression and that alone.

In this, and other ways, the relation between psychiatry and psychology- presented as competitive and/orantagonistic- is actually based on a prior mimetic relation, operating on their mutual obsession with scientificity. There is an endless proliferation of cognitive behaviour approaches that are modelled according to this semiological modifying specification. This also carried over into the current third wave cognitive therapies, especially in those based on mindfulness such as Mindfulness-CBT and the Californian sounding "Acceptance and Committment Therapy". These "updates" to the psy-wear appear to respond to existing criticisms of CBT, in particular the charge that CBT approaches the existential murk, the weft of subjectivation, the embodied physiology of affective phenomenology, and the sexuated nature of subjectivation by a crudely rationalist reductionism. If CBT ignored our physio-affectivity then Mindfulness & ACT seek to recognise them by way of "dwelling with" phenomenality. Patients are encouraged to "sit with" suicidal thoughts, to examine them as objective phenomena separate from themselves, and to learn to tolerate physiological states of hyperarousal (there is even a form of ACT for pain management; meditation being cheaper, but also safer, than reliance on opiates). If CBT codified subjectivity as entirely rationalist- and if it reappropriated the Freudian unconscious via a crude simplification and disavowal whereby the former's complexity and nuance became the simplified stupidity of "cognitive schemas"- then Mindfulness and ACT return to the unconscious via meditative techniques. Yet this update is not an update but a kind of regression and intensification. Far from addressing those criticisms we've touched on, the Third Wave returns CBT to its philosophical roots in Stoicism, a philosophy that has been criticised again and again as quietistic, overly cognitive, cruelly heartless, and, ultimately, a strange admixture of materialist and idealist elements.

Stoicism can be- too quickly and fairly unfairly- summed up in Epictetus's famous dictum: it is not things themselves that are good and bad, but your interpretation of them. What CBT proper attempted to achieve was the elucidation of the current interpretations- "schemas"- that people unconsciously lived through, identifying their irrational nature, and to recodify them into rational cognitive-skeletal scaffolding for psychological wellbeing. In the language of Stoicism, it is the philosopher's goal to master his impressions, ordering them, making them conform to the nature of things. What CBT missed was the Stoic's reticence to make normative judgements about the nature of things- these being merely more interpretations, merely more desire (desire is bad, m'kay) that enslaved the mind to the material world, and corrupted the soul of the philosopher. Thus a Stoic injunction became: make no judgements. Observe the situation but do not say it is bad; there is nothing bad outside of your thinking.

This logic was taken to the nth degree by Epictetus himself. Epictetus was a slave, and his master was a particularly nasty man. There is a story that says that the master was one day pulling on Epictetus's leg and that he did so with such force that the leg broke. Epictetus is reported to have said: "I told you that would happen if you kept pulling it". He would refer to this event in his teachings repeatedly, telling his students that the pain of a broken leg is nothing to be upset about, the mistreatment he received from the master being mistreatment only according to interpretation, and that while he had been a slave he was in fact freer than all those who had not mastered their passions and set their reason in order. In short, Epictetus's ethical philosophy was entirely idealist. This is the philosophy Hegel would dub the unhappy consciousness and that we would most recognise in the hippie inflected "radicalism" of those who see subjective transformation as itself enough to achieve materio-infrastructural reorganisation of the socio-economic. It is also at the heart of the Third Wave therapies: observe your suffering, observe the situation it takes place in, but do not judge it. This is to take the idea that mental suffering is curable through insight alone to it's logical conclusion. Insight becomes the magical device through which we dis-identify with our pain and our own subjectivity, splitting us from ourselves via this technique of "dividuation".

The hermeneutico-therapeutic (reinterpretation as therapy) suspension of judgement is thus a response to the criticism that CBT is too ready to judge emotional distress as irrational but only by way of going deeper into CBT's philosophical idealism by suspending any encounter with normativity and detaching suffering from its material causal and mediation points. If CBT attempted to depoliticise suffering by making it an issue of individual self-management, and if that self-management was in fact little more than the entrepreneurial production of brand subjectivations, then the third wave therapies go even further by refusing all valuations in the here-and-now (although ACT has a values-work component, its questionable whether orthodox therapists would agree with "destroy capitalism" as a life-value). Returning to the article on 'acceptance' of mental health problems in academia we might suggest that the university is an institution that is already practicing mindfulness itself. Of course the university has no mind, and its distributed agency cuts across different human and extra-human agencies, but nonetheless I think it's fair to make this claim.

The university is a factory for the production of cognitive-workers and units of info-knowledge capital. It is this dual process of subjectivation and value-extraction that produces the lack or hyperabundance that is experienced as psychological suffering. The university as an institutional is obliged to provide counselling services but, as the article makes clear, it has achieved an acceptance of that suffering. Psychological pain is not something one has to do anything about, it is just something one has to acknowledge, to look at- at least at the structural level of the institution. The process of responsibilisation- that is, the consolidation of the responsibility for the origin and management of psychological suffering in and on the individual experiencing it- is accompanied by Institutional Mindfulness on the other side.

Meanwhile, the third wave is being prescribed as the latest psychotechnical panacea for inteventions into the control of subjectivity. CBT and mindfulness are both empty and proliferative, lacking any core essence or general form beyond the particular nominal-pragmatic specific manualisations but nontheless flourishing everywhere. Like the Buddhist concept of the real, which mindfulness explicitly aligns itself with, the third wave of cognitive therapies is nothing and everything: a superabundant lack.

The cognitive therapies are empty of content, and attempt to empty the unconscious, but nonetheless presents itself as infinitely applicable to any and all problems. In Guattarian language, we could say that the cognitive approach has become a capitalistic meta-model, capable of reading other models, whether they are economic (return to work outcome measures), philosophical (Stoicism; DBT's emphasis on Hegelian dialectic), psychological (the combination of contradictory elements of behavioural theory, cognitive psychology, and Eastern mystical traditions). The cognitive therapies are thus perfectly suited to the fractalised temporality of capitalism, and to late capitalism's need for subjects that can self-manage their hyperarousal and consequent depressive deflation. The cognitive therapies mutate a new infrastructural complex that undergirds both capitalism and cognitive psychology itself. Felix Guattari once identified such a complex between Freud and Marx, a shared "semiotic energetics" that inherited certain ideas about energy from physics; I think we are better placed to identify the complex subtending capitalism and, following Thomas Kitwood, we might call a "hypercognitivism", meditative or otherwise, and it is an infrastructure based on precarity, flexibility, casualisation, dissolution and the uncoupling of subject-groups into dis-identified individuals- singularities without singularity.

Economic reason and capitalist therapeutics collude via their shared "semiotic plasticity" in the production of a clinical reason that every subjectivation is also the process of introjecting, carving a depth interiority upon which we can meditate, relocating the unconscious "beneath the skin", and turning us away from the exterior fields that are the proper domain of politics.

In the latest edition of the Occupied Times Joanna Moncrieff provides us with a possible new slogan for a repetition of antipsychiatry: "the psychological is political". I'm happy to agree with that slogan as long as it is recognised that "the psychological" is itself a product of forces of subjective deprivation and immaterialisation. As one of the speakers at the Occupied Times launch event reminded us, the relation of suffering to capitalism is complex, and it is one in which biology is an important moment: but we must recognise that our biology is an infolding of an immanent real, the interiorisation of the materio-energetic composition of the environment. To put this another way, the inseparability of the physical and the psychological renders the distinction of the one from the other redundant at best and a political operant at worst. Institutional Mindfulness is precisely the field that conjoins "the psychological" as an interiority with depoliticisation; any repolitisiation of the psychological has to proceed via the admission that we are, first and foremost, bodies situated in spaces that are traversed by various economic, political, and historical agencies.

To end on a note of caution: there is obviously always the need for survival. I would not advocate starvation in order to avoid being implicated in the cartography of capitalist agriculture, production and distribution chains. Likewise, there is a need for what we might call, admitting the poverty of our language, "psychological survival". In many ways the third wave represents therapeutic advances on traditional CBT, and CBT does work for a lot of people- whether it is because of the "Dodo bird verdict" or the value of specific tools. But to reiterate Guattari one last time, part of the problem of CBT is not whether it works (it seems to work as a short-term "sticking plaster")... but that it works too well!

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sometimes explode
Mar 5 2014 19:05

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  • deinstitutionalisation was not the closure of the hospital but its liberation from disciplinary enclosure. Instead of shutting down the hospital, deinstitutionalisation has opened it up, spreading it through society to infiltrate every area of our lives.

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the croydonian ...
Mar 5 2014 21:34
sometimes explode wrote:

From the clinic to the clinicality of everydaylife we witness the transformation of sadness into depression, and the proliferation of calorie information appearing on all foods and drinks, intensifying the diagnositic idea of an eating disorder, generalising it, allowing it to flow out of the strictly clinical situation, a silent declaration that we are all disordered eaters now.

Can you explain what your trying to say here because I really don't want to believe your suggesting putting nutritional information labels on food products is a bad thing and implies we all have eating disorders that compel us to madly calorie count ?!

sometimes explode
Mar 6 2014 13:25

I can only ask after the point of nutritional information, what it does, how it operates. The argument, I'm sure, is that it allows consumers to know what they're eating, the calorie content, how much fat, how much sugar and so on. But does displaying this information on the packaging really make a difference to anyone not already primed for that information? And this technique targets the population as a whole, attempting to manage the national or regional diet, but does so by offering information that is gathered by my individual eyes as I scan the supermarket shelves. So it's a population level intervention that takes effect indifferently on individual bodies that attempts to regulate what I eat and thus, in part, in conjunction with other initiatives, how fit I am, what I'm eating, where it's coming from and so on. This is pretty much the definition of biopower isn't it? The regulation of life.

Is this implying we all have eating disorders? No. But it does imply that we as populations and individuals have disordered eating. I used the term "disordered eating" because it is close to "eating disorder" but remains at a distance to it. The term does appear in the DSM IV-TR within the definition of "eating disorder not otherwise specified"- these "not otherwise specified" diagnoses exist precisely to capture the ambiguity of subjective experience. I also use the term because there is a sense in which our eating habits can all be considered disordered. A friend of mine is always keen to point out in conversations around obesity (for instance) that there is a tendency to forget that our bodies evolved under scarcity conditions relative to the dietary worlds we inhabit today. Our bodies evolved with a predilection for what were rarer fats and sugars that now flood the food market. In a sense, obesity is a predictable response to that situation, as is the will to health that means gyms seem to remain growth industries. We have a weird relationship to food. This is possibly best expressed with the endless TV shows about it, along with the fetishisation of all kinds of food (cf. Man Vs. Food; the exquisite cakes that are made more for their own appearance than for their culinary effects).

The food packaging information doesn't tackle the fact of food production- the cartography of food production- and it is another example of responsibilisation. Rather than food manufacturers being responsible for what they produce, we instead are the ones made finally responsible for what we eat. "How can you be so disgustingly fat? So unhealthy? Such a drain on the NHS? How could you dare diverge from the fit and health beauty imago? After all, we told you it had a high fat content! The massive amounts of sugar were colour coded for your ease!"

As to calorie counting. This phenomena is as common as air these days. Everyone seems to do it. With the specifics of people with eating disorders meanwhile- and I'm thinking more of anorexia here- having food everywhere is bad enough, but having that food come attached with all its specific nutritional content? So I either a) have my eating disorder effectively enabled, or b) am left unable to even enjoy this already guilty snack, because I don't just suspect that its a bad food but I now know its a bad food.

There is no reason to have nutritional information unless there is an admission that the standard of food being made under late capitalism that is available to the mass market of workers is bad for them, to varying degrees, and that we need guidance from an authority about each morsel we pop in our mouths. But this situation is somehow still our fault, our problem eating. Now we're talking about thermopolitics, a politics that rests on the idea that those in power are those who control the means of food production.

Is the nutritional information bad? Well, I don't think that's a helpful way to look at it, no. But it has negative practical effects, just as it undoubtedly has ones that do foster healthier living. The question is less about the existence of front-of-packaging information and more about the semiotic and pragmatic domains it is attached to, the packaging itself being only a symptom.

I don't know if that makes it any clearer?

jef costello
Mar 9 2014 08:42

Thanks for your post something explodes.
Croydonian: basically the information is put on there so that we are responsible for buying it, not them for making it.
I'm not sure I agree with this totally, most people have a shocking level of knowledge about food and what they eat.

sometimes explode
Mar 12 2014 20:03

Jesus I have a problem with being concise.

I'm not sure it requires agreement. It's an operation that is carried out without consultation.

isawamouse
Mar 20 2014 13:44

Excellent response. And thanks for this, and all of your blogs, sometimes explode.

JulesEvans
Apr 2 2014 08:24

Thanks, interesting connection of CBT to a broader political and philosophical context.

I'd suggest CBT is LESS normative than Stoicism, rather than more. Stoicism had positive moral goals of the good life, and an idea of the meaning of life - becoming one with the Logos, finding your good in developing your inner virtue. CBT dropped all that (understandably) and kept Stoicism's cognitive and behavioural techniques.

But I think you end up with an instrumental therapy missing any sense of how our values feeds into our thoughts and emotions, and without any ability to tell us what we should care about, and how much we should care about it.

In that sense, I think we need ethical philosophy as well as psychotherapy - therapy is not enough, there's a moral hole within it.

CBT fits with a technocratic and mechanistic society that is more comfortable talking about skills than values.

As you say, however, it does work for a lot of people, and it works partly because of its lack of moral content - people can use it whether they're atheists, theists, capitalists, communists, etc But I'd hope they then go and find a more positive moral philosophy to live by.

On which note, I think sometimes in critical theory the emphasis is so much on criticizing / deconstructing existing power structures that one loses sight of what the author is FOR. what is the philosophy of life (individual or political) that you are advocating? What would it look like? How are you trying to practice it and what are the results?

JulesEvans
Apr 2 2014 08:27

PS you say 'Stoicism has been criticized again and again' - well, yes, any philosophy thats 2400 years old will have been criticized during that time - the same goes for other ancient philosophies like Christianity, Platonism, anarchism, Scepticism and so on. The idea that Stoicism is quietistic isn't true, however - ancient Stoics were very politically engaged and many gave their lives resisting the Roman Republic's descent into tyranny. Likewise, Stoicism was a big influence on many Enlightenment activists who were anything but quietistic.

resipisence
Apr 29 2014 14:44

I totally agree that the current status of mindfulness studies and teaching rests firmly on the belief that suffering itself is inherently irrational and needs to be overcome using these methodologies. I don't see that the problem is with meditation itself, however. Developing insight into one's thought processes, training concentration and attention skills, dropping egoistic beliefs in favour of a dynamic and ever-shifting sense of self; these are all powerfully useful things that any human can attain in meditation.

If meditation practices were wedded with belief systems or ideologies that focused more on the rationality of human thoughts and emotions, then I think that the problem that you have identified here could be solved. The work of Rogers and Maslow and Bandura really fleshes out a Humanist philosophy of life, one which accepts that humans have certain needs that have to be met, that sometimes we repress certain aspects of ourselves which causes needless suffering, but also we sometimes endure suffering irrationally when there are things that can be done to change a situation.

Humanism is what I would see as the next big movement, especially in Europe where traditional churches are in decline and Humanist ministers are now being used to officiate weddings and funerals, etc. If meditation could be woven in alongside beliefs in self-efficacy (as opposed to the learned helplessness that you beautifully identify here), I think it would still play an extremely important role in psychology and just general human affairs.

Thanks for the blog post, very inspiring, definitely linking this to all the MCBT-heads I meet in the field!

the croydonian ...
Apr 29 2014 16:25
resipisence wrote:
Humanist ministers are now being used to officiate weddings and funerals

I had some friends whose friend died, the funeral was done by a humanist. Apparently it was actually a really nice funeral and quite fitting for the deceased.